66 Optic neuritis in children

Abstract Introduction Optic neuritis (ON) are rare in children. They are due to inflammation of the optic nerve which results in a sudden drop in visual acuity, or amputation of the visual field. They are often secondary to an infectious disease or vaccination, but they can be part of auto-inflammatory, demyelinating or systemic diseases. The features of optic neuritis in children are different from adults as regards high rate of bilateral involvement, poor visual acuity, and papillitis. Aim Our aim is to describe the clinical and therapeutic outcomes of patients diagnosed with optic neuritis in the general pediatrics department at the CHU of Bab el Oued in Algiers. Methods It is a retrospective, descriptive study of patients who were treated for optic neuritis in our hospital over a period of three years (January 2018 to April 2021). Results There were 7 cases, 4 girls and 3 boys with F: M of 1.3:1, mean age of 10 years and age range of 6–13 years. The first manifestation was a decrease in visual acuity in all cases, 12 eyes affected, with bilateral involvement in 5 patients. Visual acuity decrease was severe < 3/10 in 80% of cases. The visual field was pathological in 2 cases (narrow, central scotoma). All patients had headaches. Retrobulbar involvement was confirmed by visual evoked potentials in all patients, they showed demyelinating involvement. Three patients presented papillitis. The diagnostic work-up included cerebral imaging which showed old nodular abnormalities of signal of the subcortical white matter in one patient. CSF analysis revealed anti-MOG antibodies in only one case. The infection investigations were negative in all cases except positive COVID 19 serology in one case The diagnosis retained in our patients were 2 cases of Behcet's disease, 1 monophasic neuritis, 1 optic neuritis with anti-MOG, 1 CRION, 1 case linked to COVID 19 in the absence of another plausible cause. In one case, no diagnosis was retained. Seventy percent of the patients benefited from treatment with corticosteroids pulse, only 2 did not receive treatment, the short-term evolution was favorable in 5 patients with a total recovery of visual acuity, one patient has evolved into atrophy of the left optic nerve and kept visual acuity low to 1/10 of the left eye. The medium-term evolution was marked by recurrence in 3 patients, 5 episodes in the 2 patients with Behcet's disease and 8 episodes in CRION which required the use of immunosuppressive treatment and biotherapy for Behcet's disease and plasmapheresis for CRION. Conclusion Despite the fact that our small series of patients is not representative, we found similar characteristics described in children in other studies. The average onset age was 10 years, with a female predominance, the severe decrease in visual acuity with frequent bilateral involvement. The diagnosis of ON is clinical and must be considered in any sudden drop in visual acuity. The diagnosis of the underlying pathology is often difficult but it’s important in order to propose an adequate specific treatment. The treatment of children's ON is controversial and usually extrapolated from adults. Most practitioners use corticosteroids pulse. The visual prognosis seems good in children, particularly in the case of bilateral involvement, but depends essentially on the aetiology.


Background
Pediatric Rheumatology is currently gaining importance across Africa. Initiatives such as the creation of the paediatric society of the African league against rheumatism (PAFLAR) proved the efforts made to bridge the insufficiency. In the same line, training in pediatric rheumatology remains the main challenge of this orphan subspecialty. For this purpose, a post-graduate certification in Pediatric Rheumatology was created in 2021 in the Faculty of Medicine of Tunis-Tunis-El Manar University. It is the first online certification dedicated to French speakers in Africa. The certification is entitled ''musculoskeletal diseases of children and adolescents''. Objective To assess the learners' perceptions and views of this certification.

Methods
We established an online survey targeting the participants. The questionnaire was divided into three main sections: the first section examined the participant characteristics: their specialty, the use of the Moodle platform of the Virtual University of Tunis (UVT), their previous participation in an online post-graduation course, etc.). The second section focused on platform acceptability. The third and final section evaluated the content of the course. The Likert scale was used in most questions.

Results
Fifteen participants responded to the survey. Among them, one is specialized in family medicine, 1 in orthopedics, 5 in pediatrics, and 8 in rheumatology. Fifty-three percent have never used the platform of the virtual university of Tunis (UVT) before, and 26.7% have never attended an online course. Most participants found the platform easy to access and easy to use with a mean Likert scale of 2.2 and 2.13, respectively. In the third section of the questionnaire, the course met the expectations of the candidates with a mean Likert scale of 2.1. Most of them found the post-test useful to their learning experience, and only two found it to be the opposite. This can be explained by the pressure that it may generate. Eighty-six percent of the candidates had an interactive experience with the educator and enjoyed the interactions and the discussions between the participants. Most participants were pleased with the seminar organization and with the number of h devoted to each seminar (mean Likert Scale ¼ 2.1).
Eighty-six percent of the participants have found that the course improved their medical practice and 93.3% confessed that they were satisfied with the online nature of the certification and did not wish it to be physical.

Conclusion
Overall, the post-graduate ''musculoskeletal diseases of children and adolescents'' course was beneficial and enriching/rewarding for the participants. Developing this training program helps to promote pediatric rheumatology in Africa and to provide children with rheumatic diseases access to healthcare.

Introduction
Optic neuritis (ON) are rare in children. They are due to inflammation of the optic nerve which results in a sudden drop in visual acuity, or amputation of the visual field. They are often secondary to an infectious disease or vaccination, but they can be part of autoinflammatory, demyelinating or systemic diseases. The features of optic neuritis in children are different from adults as regards high rate of bilateral involvement, poor visual acuity, and papillitis. Aim Our aim is to describe the clinical and therapeutic outcomes of patients diagnosed with optic neuritis in the general pediatrics department at the CHU of Bab el Oued in Algiers.

Methods
It is a retrospective, descriptive study of patients who were treated for optic neuritis in our hospital over a period of three years (January 2018 to April 2021). Results There were 7 cases, 4 girls and 3 boys with F: M of 1.3:1, mean age of 10 years and age range of 6-13 years. The first manifestation was a decrease in visual acuity in all cases, 12 eyes affected, with bilateral involvement in 5 patients. Visual acuity decrease was severe < 3/10 in 80% of cases. The visual field was pathological in 2 cases (narrow, central scotoma). All patients had headaches. Retrobulbar involvement was confirmed by visual evoked potentials in all patients, they showed demyelinating involvement. Three patients presented papillitis. The diagnostic work-up included cerebral imaging which showed old nodular abnormalities of signal of the subcortical white matter in one patient. CSF analysis revealed anti-MOG antibodies in only one case. The infection investigations were negative in all cases except positive COVID 19 serology in one case The diagnosis retained in our patients were 2 cases of Behcet's disease, 1 monophasic neuritis, 1 optic neuritis with anti-MOG, 1 CRION, 1 case linked to COVID 19 in the absence of another plausible cause. In one case, no diagnosis was retained. Seventy percent of the patients benefited from treatment with corticosteroids pulse, only 2 did not receive treatment, the shortterm evolution was favorable in 5 patients with a total recovery of visual acuity, one patient has evolved into atrophy of the left optic nerve and kept visual acuity low to 1/10 of the left eye. The medium-term evolution was marked by recurrence in 3 patients, 5 episodes in the 2 patients with Behcet's disease and 8 episodes in CRION which required the use of immunosuppressive treatment and biotherapy for Behcet's disease and plasmapheresis for CRION.

Conclusion
Despite the fact that our small series of patients is not representative, we found similar characteristics described in children in other studies. The average onset age was 10 years, with a female predominance, the severe decrease in visual acuity with frequent bilateral involvement. The diagnosis of ON is clinical and must be considered in any sudden drop in visual acuity. The diagnosis of the underlying pathology is often difficult but it's important in order to propose an adequate specific treatment. The treatment of children's ON is controversial and usually extrapolated from adults. Most practitioners use corticosteroids pulse. The visual prognosis seems good in children, particularly in the case of bilateral involvement, but depends essentially on the aetiology.

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